Are cortisone injections for bursitis the best option?
Written by Leann Poston, M.D.
Bursitis is an inflammation of the bursa, sacs of fluid which decrease friction between the moving parts in the body. Treatment options to reduce the pain and swelling of shoulder and hip bursitis have long included cortisone injections. Cortisone injections are also used for another injury called a triangular fibrocartilage complex (TFCC) tear. You may wonder if there are more advanced options than cortisone injections to decrease the recovery time for shoulder or hip bursitis or triangular fibrocartilage complex (TFCC) tears.
Tendons attach muscles to bones, and ligaments connect bones to bones. Bursae are sacs of fluid that decrease friction as tendons, ligaments, muscles, and skin slip past each other. With overuse and repetitive motions, bursae can become inflamed, especially at the hip and shoulder. Conventional medical treatment for bursitis is cortisone injections. BPC-157 may be an adjuvant therapy that your health care provider may prescribe to speed up healing. An animal study by Pevec et al. showed that BPC-157 could improve muscle healing even after corticosteroid treatment. BPC-157 has been tested in many animal studies but has not been used in a complete human trial or been published in the literature with results from human studies for this reason it is labeled as a research medication.
The outer membrane of the bursa produces the synovial fluid inside the bursa sac. Synovial fluid is a viscous, slippery lubricating fluid. Healthy bursae are thin and allow materials such as blood cells and bacteria to enter and leave the sac.
When the synovial membrane becomes inflamed, it will thicken and produce extra fluid. If the bursitis is due to trauma, bacteria can enter the bursa and cause an infection called septic arthritis.
Bursitis is commonly from friction or trauma. Frequently, when the bursa becomes inflamed, the overlying tendon will as well.
The subacromial bursa is one of the largest bursae in the body and is found under the acromion, at the top of the shoulder blade. This compact space accommodates the rotator cuff muscles, tendons, and the subacromial bursa.
Raising the arm above the head exacerbates the pain of shoulder bursitis. The pain sometimes radiates down the outside of the arm. Arm and shoulder weakness may occur because of decreased movement and exercise.
A slight amount of swelling can lead to symptoms, including pain and inflammation. Cortisone injections for the treatment of shoulder bursitis should decrease inflammation and speed up recovery time. However, cortisone injections are not without their risks.
Symptoms of shoulder bursitis
Symptoms of shoulder bursitis may include pain with the following:
- Lifting the shoulder above the head
- Repetitive activities
- Lying on the shoulder or putting pressure on it
- Extremes of motion
Risk factors for shoulder bursitis
The shoulder bursa could become inflamed after any of the following:
- Trauma: A fall that damages the bursa may cause it to fill with blood. Blood is an irritant and may cause inflammation.
- Repetitive pressure: Moving the arm in repetitive motions over the head increases the risk of trauma to the bursa.
- Age: The risk of shoulder bursitis increases with age.
- Poor posture: Hunching the shoulders decreases the subacromial space increasing the risk of bursitis.
Trochanteric hip bursitis causes pain at the outer curve of the upper thigh. It is common in runners and ballet dancers. It may radiate to the buttock, groin, knee, and lower back. A large bursa overlying the top of the thigh bone (femur) becomes inflamed.
Symptoms of hip bursitis
Symptoms of trochanteric or hip bursitis include pain with the following:
- Walking or climbing stairs
- Lying on the affected hip
- Standing after sitting for a prolonged period
- Repetitive activities
- Extremes of motion
Risk factors for hip bursitis
The trochanteric bursa can become inflamed after any of the following:
- Injury: A fall that damages the bursa may cause it to fill with blood.
- Repeated friction at the joint: If the iliotibial band, a band of fibrous tissue between the hip and knee, is too tight, it may cause excess friction on the bursa.
- Excessive pressure: Sleeping on a hard surface may put excessive pressure on the bursa causing pain and inflammation of the bursa.
- Tendonitis: Tendinitis of the abductor tendons of the hips has been linked to hip bursitis.
Other types of hip bursitis
Iliopsoas bursitis: The iliopsoas bursa is near the groin. Bursitis of the iliopsoas bursa causes pain in the front of the hip instead of the outer curve. The pain slowly worsens.
Ischiogluteal bursitis: Ischiogluteal bursitis is an inflammation of the bursa that lies between the ischial bone and the insertion of the hamstring muscle to the bone. It commonly occurs after a trauma or from sitting on a hard surface for a prolonged period.
Treatment for bursitis
If not adequately treated, acute bursitis may become a chronic problem. If the bursa is not infected, start with RICE.
- Rest: Resting the joint can prevent further inflammation.
- Ice: Apply ice for 15 minutes at a time, 2-3 times per day for 2-3 days. Do not apply ice directly to the skin and stop if the skin becomes numb.
- Compression: Wrapping the joint in an elastic bandage decreases swelling.
- Elevation: Elevating the joint above the level of the heart decreases swelling.
Nonsurgical treatments for bursitis: Cortisone injections and other options
Nonsurgical treatments for bursitis are directed towards decreasing the inflammation in the bursa. They may include any of the following:
- Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as aspirin, ibuprofen, and naproxen can decrease the swelling and inflation of bursitis.
- Topic anti-inflammatory creams: Aspercreme and Sportscreme are topical pain relievers that have fewer side effects than NSAIDs.
- Joint aspiration: Aspirating or draining the bursa can relieve swelling and pain if the joint is not infected and can be diagnostic if an infection is possible.
- Corticosteroid injection: Cortisone injections may decrease inflammation and recovery time after aspirating a bursa when treating hip or shoulder bursitis.
- Physical therapy: Physical therapy can strengthen muscles, increase range of motion in the joints, and stretch the connective tissue.
- BPC-157: BPC or body protective compound is a fragment of a protein derived from a naturally occurring protein found in gastric juice. Consult your healthcare provider or use telemedicine to speak with an Invigor medical professional to see if BPC-157 can speed up healing and decrease the pain and swelling of bursitis.
Triangular fibrocartilage complex tear (TFCC tear)
The triangular fibrocartilage complex (TFCC) is made of tough fibrous tissue and cartilage and supports the joints between the two forearm bones, the radius and the ulna. The TFCC plays an essential role in moving the wrist, rotating the forearm, and supporting the forearm when gripping an object.
There are two types of TFCC tears.
- Type 1: A type 1 tear results from physical injury. Falling with an extended hand or overextending the wrist can cause a type 1 tear.
- Type 2: A type 2 tear is a chronic tear. These tears may occur with aging or due to an underlying condition such as gout or rheumatoid arthritis.
Symptoms of TFCC tears may include the following:
- pain when touching or moving the wrist
- stiffness or weakness of the wrist
- limited range of motion
- wrist swelling
- a clicking or popping sound when moving the wrist
Nonsurgical treatment for a TFCC tear
- Splinting or casting: Splinting or casting immobilizes the joint.
- Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as aspirin, ibuprofen, and naproxen can decrease the swelling and inflation of TFCC.
- Corticosteroid injection: Cortisone injections may decrease inflammation and recovery time with TFCC tears.
Summary: Cortisone injections for bursitis
Cortisone injections for the treatment of shoulder or hip bursitis or TFCC tears may decrease inflammation and speed up recovery time. There are risks associated with cortisone injections, including risk for infections, allergic relations, bleeding, and tendon rupture. A medical professional at Invigor Medicine is available to discuss the risks and benefits of both cortisone injections and BPC-157.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.